1104079565 NPI number — HANSON SERVICES #5 INC.

Table of content: (NPI 1104079565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104079565 NPI number — HANSON SERVICES #5 INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANSON SERVICES #5 INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104079565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14600 DETROIT AVE STE 420
Provider Second Line Business Mailing Address:
P.O. BOX 771222
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44107-4299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-226-5425
Provider Business Mailing Address Fax Number:
216-226-5623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13571 MCGREGOR BLVD
Provider Second Line Business Practice Location Address:
SUITE 26
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33919-6057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-433-0230
Provider Business Practice Location Address Fax Number:
239-437-7111
Provider Enumeration Date:
10/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEININGER
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
239-433-0230

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  NR30211234 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)